Abstracts from the XIIth Scientific Meeting of the Argentine Society of Arterial Hypertension

Epidemiologic Survillance of Cardiovascular Disease Mollar G, Cavalieri L, Galarza C, Waisman G, Beratarrechea A, Petrlik E, Langlois E, Soriano F, Marchetti M, and Gonzalez B de Quirós F Programas Médicos de Plan de Salud del Hospital Italiano de Buenos Aires

To enhance efficacy of health care, surveillance activities are required, especially with chronic prevalent diseases. Epidemiologic surveillance allows US to quantify and qualify health problems, settle priorities, identify high risk groups, manage and monitor health care systems, detect frequency changes in events, and assess performance of prevention and disease management programs. We have developed a surveillance system that identifies and reports daily on patients having cardiovascular disease (CVD) who are uncontrolled.

Objective: To evaluate the accomplishment of blood pressure (BP) measurement in people with CVD belonging to a health care system included in an epidemiological surveillance list.

Design: Cohort study between 1/1/2004 and 9/1/2004.

Methods: Patients 60 years old or older identified by surveillance system during the first term of 2004, were followed up. Patients were identified as having CVD through electronic medical record using international classification for primary attention (ICPA).

Patients are reported by the software system when presenting any of the following criteria: no blood pressure record during the past 6 months, blood pressure above 140/90 in the last record, and if diabetic A1C above 7.5%.

The connection with the appointment system allowed us to detect previously the patient’s attendance and, 15 min before his or her medical appointment, send the patient to be examined by the executors of a chronic disease program, according to the JNC VII guidelines.

The BP measurement is a common intervention to most chronic diseases because it increases cardiovascular risk, hence it is considered a process indicator of the surveillance system.

Results: Of the 24,411 patients having CVD, 5506 (26%) were listed during the first term, mean age was 74 years and 65% were female. By the end of 2004, 4660 (85%) patients had blood pressure recorded with an average values of 136.76 mmHg for systolic and 77.51 for diastolic blood pressure. Blood pressure was assessed three times in average.

Conclusion: Surveillance system allowed identifying of and intervening in a high proportion of patients.     

Rudolf Virchow: The physician as politician

Rudolf Virchow's life is an eloquent instance of the way professional and political activities can and should be integrated, if physicians are to live up to the highest ideals of the profession. At one and the same time father of pathology and father of social medicine, Virchow carried the results of his research to the public arena by advocating such measures as medical care for the poor, compulsory meat inspection to eliminate trichinosis, and the improvement of public sanitation. Elected to public office, Virchow led the protest against Bismarck's militarism despite the personal risk involved. His disarmament resolution, had it been accepted, might have averted the tragic Franco‐Prussian War of 1870.

Few of us can match his scientific accomplishments. Every physician can be inspired by his personal courage and his commitment to humane values. No task can be higher on the agenda of medicine than the defence of peace, the precondition for health in the nuclear era.     

Peroxyacetyl Nitrate Inhalation

The eyes of rhesus monkeys and humans were exposed to long-pulsed ruby and neodymium, Q-switched ruby and neodymium, and helium-neon (He-Ne) lasers to determine retinal damage thresholds. Rabbit eyes were exposed to a carbon dioxide (CO₂) laser to determine corneal damage thresholds. The data were gathered simulating accidental field exposures.

The experimental data show that the white human fundus is appreciably less sensitive to damage from laser radiation compared to the rhesus monkey fundus. In general, the human threshold data obtained are considerably higher than some of the recommended safe levels.

Corneal damage levels caused by CO₂ laser radiation were reported. The data were shown to be consistent with a simple thermal model.

We emphasize that we are presenting experimental observations and are not recommending energy levels for “safe” laser exposures.     

Psychiatric Principles in Medical Interviewing

Asymptomatic splenomegaly is clinically intriguing. The commonest conditions found in Mayo Clinic patients with splenomegaly are portal hypertension, agnogenic myeloid metaplasia, Gaucher's disease, and splenic cyst, but differential diagnosis may be difficult. The physician may have to use laboratory and liver function studies, angiography, liver biopsy, and even surgical exploration to determine the etiology of the condition.